Background and Study Methodology

The Social Science component of the Programme began developing the initiative on Family planning and sexual behaviour in the era of HIV/STDs in 1996. Two background papers were prepared and a research workshop was organized in Nairobi, Kenya, where researchers and policy-makers from the region discussed the situation in their countries with regard to contraceptive prevalence and HIV/STD prevalence, identified gaps in knowledge, and defined priority topics and questions for research. The workshop was jointly organized with Africa Population Policy Research Centre, The Population Council and the Joint United Nations Programme on HIV/AIDS (UNAIDS). Following the workshop, a draft protocol was prepared and reviewed with the participating investigators in a workshop held in April 1997 in Durban, South Africa. Both qualitative and quantitative research methods are being used in this study which is expected to be completed in 2000.

Methodology

This study is being conducted with an urban and a rural sample selected in one district from each of the six countries: Kenya, South Africa, Tanzania, Uganda, Zambia and Zimbabwe. The districts have been chosen for their relatively high contraceptive use rates, their importance as foci of the HIV epidemic, and the contiguity of suitable urban and rural study sites.

Areas of research focus include sexual negotiation between partners, attitudes to risk-taking and perceptive of risk, and how these differ with regard to the risk of pregnancy and HIV/STD infection. Investigations into attitudes to various types of contraceptive method in different sexual relationships are also being covered.

To investigate attitudes to sex, the study relies on in-depth interviews which are representative of a broad range of sexually active adults, both users and non-users of family planning, and both those whose behaviour (or whose partners' behaviour) places them at a high risk of contracting an STD, and those at low risk.

A two-stage study design, borrowing certain methods from epidemiological case–control studies, has been developed in order to achieve a representative distribution of in-depth interviews. A community-based sample survey using structured questionnaires is being used to find out about the use of family planning, marital status, child-bearing intentions, knowledge about STDs and sexual behaviour. The results of the survey will be used to select a limited number of individuals for further study. The selection of individuals will be non-random, with an attempt being made to match individuals ("cases") whose behaviour places them in a high-risk category for STD infection with those at low risk of STD infection ("controls") with respect to other variables, such as use/non-use of family planning, desire for children, rural/urban residence, etc.

Focus group discussions, the results of which are reported here, were employed as a preliminary tool to clarify the concepts and language used by ordinary people in discussing sexual activity, STDs, etc. They also provided contextual information on attitudes to family planning and sexual health.

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